Abstract
BackgroundStaphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.MethodsIn this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months.Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.ResultsIn this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.ConclusionCombined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.
Highlights
Only 2 case series have reported on the efficacy of an oral clindamycin-rifampin combination therapy regimen for staphylococcal periprosthetic joint infections (PJI) in adults, with a success rate of 70% in 7 cases and 100% in 6 cases [6, 19]
We evaluated the efficacy and safety of a clindamycin-rifampin combination therapy regimen for the management of PJI caused by Staphylococcus species
Of the 89 patients treated with Debridement and implant retention (DAIR) or one-stage revision, 51 patients had a staphylococcal PJI
Summary
Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI. Clindamycin has been shown to be effective in treatment of osteomyelitis [8], has excellent bioavailability, high levels of penetration into synovial fluid and bone [9, 10], inhibits biofilm formation and bacterial adherence and is well tolerated [11, 12]. Only 2 case series have reported on the efficacy of an oral clindamycin-rifampin combination therapy regimen for staphylococcal PJI in adults, with a success rate of 70% in 7 cases and 100% in 6 cases [6, 19]
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